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Hematoma prevention important in reducing morbidity, mortality from THA

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The aggressive prevention of hematoma can help lower complication rates, morbidity and mortality in patients who undergo total hip arthroplasty, according to a recent presentation.

Patricia L. Hansen, BS, shared her team’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

“As is well known, hematoma formation after total hip arthroplasty is a serious event which can lead to return to the OR, infection, pain and nerve injury,” Hansen said. “We wanted to quantify the incidence of hematoma after [total hip arthroplasty (THA)], as well as the risk factors and outcomes associated with it.”

Hansen and her team matched 38 hematoma cases requiring irrigation and debridement within 6 weeks of primary or conversion THA between 2000 and 2007 to a 107-patient control cohort. Mortality rate was calculated through the Social Security Death Index, complications were determined through chart queries, and patients were called for Harris Hip Score (HHS) and Satisfaction Score (SS) reports. Mean follow-up was around 4 years, Hansen reported.

According to the study results, hematoma was identified as an independent risk factor associated with lower HHS, lower SS, greater mortality, and more complications. Chronic anticoagulation was also associated with lower HHS, hormonal therapy was associated with lower SS and more complications, and increased calculated blood loss and presence of therapeutic perioperative anticoagulation were associated with more complications.

Chronic anticoagulation also was revealed to be an independent risk factor for mortality.

“The incidence of hematoma is not negligible,” Hansen concluded. “Anticoagulation status and blood loss are closely related to hematoma formation, and therefore anticoagulation should be stopped as early as safely possible prior to surgery.”

“The take-home message is that hematoma needs to be prevented aggressively,” she added. “This complication increases morbidity and mortality despite adequate treatment.”

Reference:

• Hansen PL, Kane P, Zmistowski B, et al. Hematoma after primary total hip arthroplasty: A grave complication? Paper #357. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
• Disclosure: Hansen has no relevant financial disclosures.

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